When accidents happen

09 December 2009 Comments

Awareness of road safety is not big here in NWFP. Firstly, many of the roads hardly deserve the name and that certainly doesn’t help. But more significant is the general attitude of what I can only describe as recklessness (or perhaps carelessness?) displayed by most drivers and pedestrians alike. The result: road accidents are a frequent cause of the local population presenting at our emergency room, and the injuries are often horrific.

 On the way to and from work, I have my eyes closed half the time (no, I don’t drive myself) and find that I catch my breath at regular intervals as a result of the various manifestations of traffic chaos that are happening all around me.

The vehicles here are a kaleidoscope: from lumbering, elaborately decorated trucks to battered donkey carts; minivans and rickshaws; huge tractors with trailers in tow and, of course, there are motorbikes everywhere (though helmets are vanishingly rare). And all of them are heavily loaded (with people – inside and out – livestock, and every type of merchandise, material and equipment) to the point that I marvel they are able to move at all. Every junction point, street market and crossing is a seething mass of impatience – everybody wants to be first, in front, going faster and will do everything they can to make sure this is so. Add pedestrians to this mix, all with a bundle, bag or tiny child (!) to slow them down or obscure their view, all trying to squeeze through the smallest of rapidly closing gaps between the vehicles, and you can begin to understand why this is a catastrophe waiting to happen. It doesn’t have to wait long.

Everyday they come to the ER: broken arms and legs, lacerations and bruises – and those are the minor cases. Then there are those with head trauma, the crushed chests and abdomens, the terminally mangled bodies….But, this is why I am here and the other day this is how I met two 20 year old lads. If only we had met under different circumstances.

They had been on a motorbike together, riding, carefree but too fast. In the crash they both sustained multiple injuries: each had broken a leg, fractured several ribs and both were unconscious.

I was not in the resus room when they first arrived and by the time I got there the MSF nurses on shift had already done a lot to stabilise them. I am lucky to work with an excellent team but we were all pushed to the limit that day. The demands of an emergency like this are hard to relate. Both patients needed my immediate and undivided attention but this was obviously impossible. And in those first few moments I want to shake them, to shout “WHY WEREN’T YOU WEARING HELMETS? WHY WERE YOU DRIVING SO FAST?!?” but what use would that be…

All that is left is to slip into the familiar routine: Airway, Breathing, Circulation, are the cannulas in, lets speed up that IV fluid and keep ventilating, have we checked the back, please get a chest drain kit open for number 2…ok (breathe…), what’s the blood pressure now, let’s review what we’ve done so far. My well-trained team are slick and practiced in their movements and over the next hour and half we do what we can to stabilise our patients. One is beginning to wake up – a good sign – but he is far from out of danger. As for the other, I am concerned that he may already be too far-gone. We manage to get a unit of emergency blood for him, the transfusion might just be enough to keep him alive during the two hour ambulance transfer to the nearest trauma surgery centre, but even if he makes it that far there are no guarantees he will survive.

In another well-practiced routine, we prep and package them for the ambulance. As it rolls away from the hospital, I can’t help thinking that it is all such a tragedy for such young lives. We are exhausted, our only comfort being a job well done. There is every chance we will face the same thing tomorrow.

South Africa has a road accident problem that can easily rival what I have encountered here. So I want to end by asking that wherever you are driving today or tomorrow, please be careful. Wear your seatbelt, put your child in the safety seat (everytime!) and SLOW DOWN. To do otherwise, well, it’s just not worth it.